The Patient (2 page)

Jonathan Brewster had been told to prepare an acceptance speech, so it was with a sense of triumph that he rested his knife and fork on his plate and surveyed the scene at the annual marketing-awards dinner. It had been a long hard struggle, but at 47 he could truly say that his career had taken off; for a year now he had been heading up his division, and profits were up. It had meant even more hours in the office – albeit a much bigger office, with floor-to-ceiling windows overlooking the whole city. It also meant he could get a house in the kind of suburb that makes you enjoy giving your address out to others and that his girls could finally go to the private school he had always dreamt of sending them to. Tracy, his wife, was radiantly beautiful tonight, as ever.

Little did Jonathan Brewster know that at the very moment he was smiling and waving at other dinner guests and checking that his speech was still safely in his pocket, cells in his bladder were rapidly multiplying. In fact, they had started growing the day he was promoted. Each day, they had multiplied at an increasing rate. By now, they
had formed themselves into the most beautiful fronds, like delicate red coral emanating from his bladder wall. Some of the cells had burrowed deep down into the wall. Others had formed sheets, like scarlet carpets, extending into the channel between the lining of the bladder and the blood-rich tissue underneath. Some of the cells had acquired the ability to travel – to leave the bladder and explore new and wonderful parts of the body – though none had done so yet.

His name was called to accept his division's industry award. He kissed Tracy, rose from his seat and walked to the stage, beaming and waving to a colleague here, a jealous competitor who missed out there. This was his moment of glory.

And the rapidly multiplying cells in his bladder would have to wait only until dawn to have theirs.

Jonathan Brewster stared at the macabre scene that surrounded his toilet and was filled with an overwhelming fear.

Just a quarter of an hour ago, his biggest concern had been getting out of bed in the cold and interrupting his sleep a good two hours before he had to get up for work. He had tried to ignore the pressure in his bladder that had awoken him, rolling first one way, then back the other, until finally he'd found the right position: lying on his back, with his knees drawn up. But this had only worked for a few minutes; then the discomfort of holding on had exceeded the discomfort of getting out of his cosy bed.

Not wishing to wake Tracy, he'd tiptoed into the en suite bathroom, walked quickly to the bowl, lifted the seat (he was well trained by his wife) and stood there in the dark holding his penis, waiting.

Nothing had happened – except that the pressure had become more uncomfortable, more intense. Slowly, a trickle had commenced. Then it had stopped. A deep spasm had hit his groin, making him gasp. It would have been almost
sexual had it not been for the unbearable desire to urinate that had accompanied the pressure in his pelvis. The spasm had strengthened, and Jonathan had found himself letting out a faint hum from his throat; he'd realised he'd been holding his breath.

Suddenly, it had felt as though a plug had come free from his penis, and then there'd been a gush of urine. The relief had been wonderful.

Dawn was filling the sky with a gentle light, bringing the bathroom dimly into view. He'd been curious to see that his urine had sprayed all over the bowl, the floor and the soft white mat he'd been standing on. It had occurred to him that in the half-light he should not have been able to make out spots of urine. That he could had indeed been strange.

Jonathan had closed the door gently and turned on the light. At first he could not grasp the macabre scene that confronted him. His senses were overwhelmed by a profound terror, the type that makes hair stand on end and skin go icy cold.

The urine in the bowl, on the floor and on the white mat was red. In fact, it looked very much like blood. His blood. His legs feeling weak, he sat down roughly on the cold white tiles, shivering at the sudden change of temperature. Jonathan's world was turning around him. It all went black, and he fell backwards, hitting his head on the door.

Tracy heard the loud thud and rushed out of bed. ‘Jon, what is it?' she cried out. ‘Jonathan!'

She had to push on the door with her full weight to shift his limp body. One great shove and she had enough room to squeeze through. Blind panic hit her at the sight of blood all
over the white bathroom and Jonathan's naked body splayed out on the tiles. Shouting his name, she shook him, trying to wake him. His skin felt warm, but he was very pale. He reminded her of movies she had seen where the wife walks in to discover that her husband has committed suicide, but even as she reached down to check his wrists she knew this was a ridiculous thought; he had everything to live for. Jonathan's eyes slowly flickered open. It was then that she glanced down and saw the blood at the tip of his penis.

‘Shit, shit, shit!' she yelled. She was usually meticulous about her language, but ‘shit' seemed to be the most appropriate response now.

Jonathan was trying to sit up.

‘Oh my God, Jon. What happened?'

‘I just needed to pee, and then it all came out suddenly, like a gush,' he said. ‘When I saw the … the blood, I … I …'

‘Shh, it's OK now, babes,' said Tracy soothingly.

Jonathan had never been good with blood. In fact, he had a long tradition of fainting at the sight of it. At a rugby game at school, he had passed out when an opposition player's head was split open during a rough tackle. He had even fainted during the birth of his first child, Emma, knocking over several instrument trolleys in the process. Minutes later, Tracy had given birth to Emma while the staff tended to Jonathan, who was flat on the floor.

But this blood was more frightening than any he had seen before. This was his blood. He felt faint again as he looked around the bathroom. The droplets and streaks of blood gave the scene an abstract horror, almost like modern art – a red Jackson Pollock.

‘Fuck, Tracy, that's my blood there.' He was struggling to understand.

‘Let's get you back in bed,' she said, trying to get him away from the scene so he wouldn't faint again. She knew her husband well. ‘Do you think I should call an ambulance?' she added.

‘No, no, I'll be right. I just don't know where this came from. I should help you clean it up,' he said, avoiding looking at the bowl.

‘No way. You get back to bed.'

Tracy got her husband to bed and went back to the en suite, where she took some bathroom cleaner and a sponge from the cupboard under the sink and began cleaning up the mess. Then she started on the toilet – but something immediately caught her eye and she stopped. In the bowl was a black object about the size of a scrunched-up tissue. She bent down to look at it closely and, as she did, she gagged. It was a clot of blood. She flushed and then quickly scrubbed the bowl. By the time she'd finished, the room looked more like a bathroom and less like a crime scene.

‘I'll make us coffee,' she called out as she washed her hands.

Jonathan nodded; he was checking his pager for messages, mainly to comfort himself with the familiarity of this everyday task. He was still pale but was returning to normal quite quickly.

‘You know, Jonathan, maybe you've got an infection or a stone or something,' Tracy said when she came back in the room.

‘It's cool, Tracy. I feel fine now.'

‘No, no, you need to go see someone, Jon. There was
like a … a clot thing in the toilet. We'll get onto the doctor as soon as he opens this morning,' she said and headed for the kitchen.

She was already mentally rearranging her day. Tracy could see her schedule laid out like a series of blocks in her mind's eye. First was getting the girls to school, then she had meetings with four clients lined up and then they had Anne Marie and David coming for dinner, so she was supposed to shop and cook in the afternoon. Jonathan was forever making generous gestures that Tracy always seemed to end up having to fulfil. Anne Marie and David were nice enough, but this was a school night and she'd told Jonathan she was facing a busy week. He'd said, ‘Don't worry about a thing. I'll arrange it all – shopping, cooking. You relax.' As usually happened, he had had a last-minute meeting scheduled that was ‘really, really important', so the job had fallen to her. Situations such as this had caused conflict during the course of their married life, but never to the extent that it diminished Tracy's love for him. Many of their friends were already onto their second marriages, but Tracy and Jonathan still shared a wonderful marriage, even with the frustrations that Jonathan created.

‘I'll ring and cancel dinner,' she said as she brought in the coffee. ‘You've got the board meeting on today, haven't you?'

‘Yeah, I have to make that presentation. I'll be finished about six – don't cancel dinner. Honestly, I'm fine. I feel OK. Thanks, Trace,' he said as she handed him his coffee.

‘Uh, Jon, are you nuts? You've just peed blood everywhere and you want to have some people over for dinner that you hardly know? You must be kidding.'

‘It's just that I think Anne Marie could wind up being a big client for me. And you enjoy her company. She's just like you – intelligent, professional …'

The sweet talk was getting Tracy even more irritated. ‘I'm cancelling dinner. And you're going to the doctor.'

Jonathan could tell when Tracy was not to be swayed; he gave up the notion and they finished their coffees in silence.

He rested his cup on the bedside table and realised he once again felt the need to urinate. Tracy followed him into the en suite. They stood over the bowl, waiting to see the colour of his urine.

‘If there's more blood, we're going straight to the hospital,' Tracy said.

‘I can't pee with you standing here looking at me.'

‘For God's sake, just do it.' Tracy was impatient now. Impatient and scared. Thoughts of disaster flashed through her mind. What if her husband was sick with something serious?

Jonathan was grunting now, trying to force urine out. Finally, he urinated. It was lighter than before, but it was still bloody. The sight made him feel faint again.

Tracy got him back to bed, called her mother and asked her to come and sit with the girls. Her mother and father lived two streets away and were used to filling in the childcare gaps. They were early risers, so they were awake when the phone rang – but still, they were understandably shocked.

Tracy dressed quickly, threw Jonathan a tracksuit and explained to the girls what was happening. Jonathan still looked a little pale, so when her parents arrived Tracy was
the one who got in the driver's side of their new car. She had not mastered the gears, and it was a clunky ride to the Victoria Hospital. She dropped Jonathan off at the front door of the Emergency department and went to park the car. The bright-red signs inside the building left him in no doubt about which way he was meant to go.

Fuck
, I thought as my beeper went off again. I was just finishing off in theatres. A boy of 12 who'd had a sore left testicle for the past day had been admitted. This was a urological emergency, because if he had torsion of the testis – when one of the testicles becomes twisted within the scrotum – its blood supply would be compromised. If that lasts for longer than the magic number of four hours, the tissue dies and the testis has to be removed. The only real option was immediate surgery to explore his scrotum.

While I was always careful, I did feel an enormous extra pressure on me because his father was a barrister renowned in the field of medical professional negligence. As the Urology registrar on call, I had thought it best to first contact the head of department, even though he was at home.

Registrars are trainee specialists who, after graduating from medical school, have gone through three of the tiers of the hospital system, from entry-level intern (which lasts a year after graduation), to resident (the position between intern and trainee specialist), to securing a training position, which typically lasts for three years before the registrars are ready to take their specialist
examinations. As they are still trainees, albeit experienced ones, they report to the specialist on call. In this case, it happened to be the head of department.

In his sleepy state, the head had given me permission to perform the surgery, adding, ‘Ring me if you have any troubles.' This was a standard response, in line with the truism that a registrar's competence miraculously increases after midnight.

I had incised the boy's scrotum and revealed his testis, which in fact was in torsion and terribly ischaemic – starved of blood and therefore oxygen. Irreversible damage had already occurred; I had no choice but to take out his testis. I did that and then closed his wound. It was now 1 am. I had been operating for over 16 hours in a row.

‘Dr Khadra here. I was paged …
again
,' I said down the phone once I had finished the surgery. I was cross and tired. I had not eaten anything since breakfast the previous day except for some biscuits, and my head was starting to hurt.
It will probably turn into a migraine
, I thought.
Maybe I should take an anti-migraine pill
.

‘I'll just see who's looking for you.' It was the ward clerk.

The phone clunked. In the background, I could hear the general din of Emergency. It was obviously busy. Some nights, it seemed that every diseased human in the world had descended upon the Victoria Hospital intent on testing out the system and finding its faults. Tonight was such a night.

I was sitting in the theatre tearoom, where, in the past, before economic rationalism, one could actually get a meal. ‘Hello … Hello … Helloooooo,' I said into the phone, speaking to no one in particular. I heard someone's voice nearing the phone, and then it clunked again.

‘Hello, who is on the line?' asked a new person, a woman.

‘Dr Khadra. I'm the Urology registrar. I've been paged.'
I probably wasn't doing a good job of hiding my growing exasperation.

‘Did anyone page Urology?' she shouted to all of Emergency – and into my ear.

Clunking again – the phone being placed down on the desk roughly. I decided to hang up and just go down in person.

The junior resident – who was only just out of his first year as a doctor – was looking somewhat shell-shocked when he greeted me.

‘I'm glad you came down. We have an absolute doozy here. I really need you to take a look.' As he spoke, he led me to a cubicle. I parted the curtains and saw a heavily tattooed obese man.

‘Hi. My name is Mohamed Khadra. I'm the Urology registrar on call. What seems to be the trouble?' I asked as I nodded to the resident to let him know he could go. He chose to stay.

‘You don't look like a Mohamed,' said the tattooed man, smiling. ‘I expected you to be black!' I heard that comment at least once a day. I just waited for him to start talking about his urological concerns. ‘Well, me ring tore out,' he said.

‘Your ring?' I could not quite grasp what he was saying, as this sounded more like a job for the Proctology department.

‘Yeah, me ring.' As he said this, he nodded towards his groin.

‘Do you mind if I have a look?' I asked, dying to solve the mystery.

I pulled down the blankets and lifted up his white hospital gown. There was a pool of blood between his legs. The end of his penis had the dramatic appearance of a frill-necked lizard. Hanging from a loose bit of torn skin was a large metallic ring, a Prince Albert. It had been inserted through the end of the man's urethra and then out through the middle of the penis. To this
was attached a chain, which ascended to another body-piercing extravaganza around his nipple.

‘How did it tear?' I asked.

‘Well, I was watching a movie with a friend of mine and I got up and had to bend down to change the video. As I stood up, I think I stepped on the chain, and wumph … the ring got torn out.'

‘It must have been very painful.' I could not help but wince.

‘It was, doc, it was,' he said sadly.

‘I'm just curious to know, why did you have it inserted in the first place?' I really was curious.

‘It makes sex so much more pleasurable, doc. You should consider it.'

There was no way on earth that I was going to adorn my penis with a Prince Albert.

‘Can you fix it?' he asked.

‘Yes, we can. We need to get you to theatres as soon as possible and sew your penis back up.'

‘And how soon do you think it will be before I can have another one?'

For a moment, I hoped he was joking, but no, he was serious. ‘I suspect never. You have a complete tear through the penis, the urethra and the skin. It will take a while for all of that to heal. Even then, I suspect the skin will be too thin to be able to bear the weight of another Prince Albert.' I resisted the temptation to tell him he needed psychiatric care a lot more than he needed another ring.

‘Hey, is there any chance of something for the pain, doc? I think it needs to be morphine or pethidine.'

I guessed he must also be a narcotic addict. ‘I'll see what I can do,' I said – and wrote him up a script for some anti-inflammatory medications for the pain. He was not happy.

I went back up to theatres to see if I could book this man's operation. After hours, theatre access was very limited. One had to battle with all the other surgeons trying to do their emergency cases.

‘Marlene, what's on the table now?' I asked the night theatre supervisor, who had been in the position as long as anyone could remember.

‘Why do you want to know? What delights have you got for us now?' She guarded theatre time fiercely.

‘I have a fellow who has a nasty laceration on the end of his penis. It will take a couple of hours to get it all back together again. What time do you think we could get a guernsey?' I asked, looking as cute as I could.

‘Why can't he wait till later in the morning? Cancel your elective list and do him instead.'

‘The boss will be very cross. He's lined up a drug rep to bring in the new laser-prostatectomy machine to try it out. It's going to be a circus.'

Jim, the head of Urology, was an expert at extracting money from the hospital administration for new technologies. Several of his previous acquisitions were in the store room, collecting dust. He was always falling victim to the intensive marketing techniques the medical-technology companies used on doctors to make them feel that without the latest technology they were offering their patients a lousy standard of care. Public patients were waiting for years to get their hips replaced, but millions of dollars were spent on new technology that was redundant before the hospital had even recouped the cost.

The old equipment would have been useful to hospitals in the developing world, but red tape made donating it impossible. One bureaucrat had prevented a disused heart–lung bypass
machine from being donated to Kenya lest it malfunction in the future and the Kenyans decided to sue the hospital. Even more distressing to any with a sense of social justice towards the developing world was that most new technologies have very questionable cost–benefit analyses when one weighs their purchase for our hospitals against providing hospitals in developing countries with even the most basic of needs. Some lack antibiotics, anaesthetic solutions and even suture material. They make do, and we spend more.

Jim had been impressed with the marketers' pitch for the laser-prostatectomy machine at a conference in Paris and was angling to purchase one for the Victoria Hospital. His arguments would be along the lines of needing to keep the hospital at the forefront of health care: how can you call it a teaching hospital when the technology is ancient? The machine will save money in the long term. The cost can be amortised by shorter hospital stays for patients. If his debates with administration failed, he could always use his secret weapon: he was one of the few people in the city who had direct access to the health minister; they had gone to school together.

‘Well, there's a vascular case on table, and it's going to be followed by the orthopods,' said Marlene, trying to find a solution. ‘You could probably follow.'

‘Thanks, Marlene.' It was going to be another night with no sleep and me getting uglier for it.